Honor Society of Nursing, Sigma Theta Tau International

Transcription

1 Honor Society of Nursing, Sigma Theta Tau International 23rd International Nursing Research Congress Brisbane, Australia 30 July - 3 August 2012 Session: Global Nursing Research: Violence Against Women Learning Objective 1: The learner will be able to explain the differences of stigma perceptions between rural and urban Kenyan women living with HIV/AIDS. Learning Objective 2: The leaner will be able to identify key themes of the Kenyan women experiences and how they compared to their stigma perceptions.

2 Kenyan Women Living with HIV/AIDS: A Mixed Method Study Kenyan Women Living with HIV/AIDS HIV Pandemic in Sub-Saharan Africa August 1, :30-2:45 PM By Rosemary Mwangi RN, PhDc Research Questions Literature Review Research Design & Limitations Study Variables & Findings Study Implications /Knowledge Dev. Summary & Conclusions

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4 Sub-Saharan Africa Sub-Saharan Africa Kenya W/me n SSA 42% Rest of WD 32% Men SSA 26%

5 HIV Epidemic Update (UNAIDS/WHO, 2011)

6 Demographics HIV infection by 2011 Sub-Saharan Africa F&M 2011

7 Research Questions Quantitative What are the characteristics of the Kenyan women living with HIV/AIDS comparing rural & urban? What are the differences of stigma perceptions between women living in the rural setting compared to those living in the urban setting? Qualitative What is it like for you to live every day with HIV/AIDS? How does it make you feel? MIXED: How do the experiences of women living with HIV/AIDS compare to their scores on the STIGMA Scale?

8 Literature Review Stigma: Definition as a powerful discrediting and tainting social label that radically changes the way individuals view themselves and are viewed as persons ( Alonso & Reynolds, 1995, p. 304) In his seminal work Goffman 1963 defined stigma as an attribute that is deeply discrediting (Goffman, 1963, p. 3)

9 Study Stigma Variables Major Variables Fear of Contagion (covered by 6 items) Healthcare neglect (Covered by 7 items) Negative self-perception (covered by6 items) Social Isolation (covered by 5 item) Verbal abuse (covered by 8 items) Workplace stigma (covered by 2 items) (Holzemer et al, 2007)

10 Data Analysis

11 Demographic Characteristics Continuous variables compared using an independent samples T- test revealed: Significant differences in means between the urban and rural samples in age (p <.001) and income (p <.001).

12 Demographic Characteristics 2 Categorical demographic variables compared between urban & rural using Chi Square showed: Significant differences noted as (p<.001) in: language,age group, education, source of income, type of work, started on HIV meds, taking HIV meds, provider of meds, support group knowing viral load (p<.05)

13 Correlations between Stigma Perceptions

14 Mean Stigma Scores & Stats

15 Differences in Stigma Perceptions between Rural and Urban Women

16 Significant Correlations: Demographic Variables & Stigma Constructs Setting (rural/urban) (r =.394, p<.001) Language (r = -.312, p<.001) Education (r = -226, p<.001) Income (r = -.189, p<.01) Years since AIDS diagnosis (r =.228, p<.001) On HIV medication (r =.215, p<.01) Taking HIV medication (r =.215, p<.01) CD4 count (r =.196, p<.01) Support group (r =.383, p<.001) assistance needed (r =.170, p<.05)

17 Qualitative Analysis N 27 : 18 participant urban; 9 rural Interpretative Phenomenological Analysis by Smith, J. A., Flowers, P. & Larkin, M. (2009). NVIVO and manual clustering of data utilized Themes Super Ordinate themes

18 Major Themes Feelings of living with HIV General everyday challenges and experiences living with HIV/AIDS Experiences with husbands Relationships with extended family Healthcare experiences Work experiences Social issues or concerns & stigmas Sources of personal strength Current experiences, taking charge Message to others

19 Super Ordinate Themes Feelings of shock and fear, rejection and abandonment, worthlessness and being alone with the added responsibility of caring for children Care & support received from third party: individual or organization Dichotomous nature of healthcare settings Societal Stigma

20 Self- stigma Themes of Interest (1) Rejected, abandoned, ostracized, and demonized Secrecy of both infected male, family & healthcare providers toward women Children: parental/child care burden, education Care and support received from others Land and property disinheritance: lack of resources and poverty

21 Themes of Interest (2) Significant support and acceptance shown by Catholic Sisters or Catholic hospitals Discordant couples and sero-conversions from positive to negative Forgiveness and reconciliation Resilience and servant hood

22 Significance to Nursing Knowledge Development

23 Implications for Practice Understanding of patient experiences of stigma and discrimination will impact planning and delivery of quality care Promote understanding of how the women make sense of their world Results of study may assist in development of contextual resources for the care of this population

24 Implications for Practice Healthcare programs tailored to specific research findings: respective geographic settings & not one program that fits all Age appropriate healthcare due to an aging population of the women in rural settings; data shows much lower level of education e.g. aging and S/effect of medications, menopausal/postmenopausal effects; income; nutrition

25 Implications for Practice A need to include stigma perceptions measures and interventions as part of clinic/inpatient assessments e. g using questions like: Do you have personal concerns related to your being diagnosed HIV/AIDS? Are you undergoing concerning experiences from others due to your being diagnosed of HIV/AIDS? Monitor stigma overtime

26 Implications for Practice Advocacy and social/political support for women living with HIV/AIDS Introduction of healthcare collaborative meetings that include women living with HIV/AIDS Stigma impedes treatment, prevention and adds suffering to HIV/AIDS families

27 Implications for Education Nursing curriculum integration of practical ways of addressing stigma from a moral /ethical/spiritual and cultural perspective On going dialogue of the woman s place in society in R/T cultural values and practice that disempower woman Social/Political involvement: poverty, social injustices

28 Review and Conclusion

29 Conclusions / Summary Findings consistent with Literature review Need for further research to uncover cultural constructs related to HIV/AIDS stigma among different ethnic groups Transforming nursing research into practice will enable us to get into the trenches in combating HIV/AIDS stigma and discrimination.

30 Conclusions / Summary We may not eradicate stigma and discrimination overnight but we can impact one life at a time! One mother s life saved, one less orphaned child! Stats become faces of people!

31 Thank You!